Understanding pressure injuries

A pressure injury is an area of damaged skin, and often damaged tissue underneath, that forms where the body rests against a surface for too long. Bed sore, pressure sore, pressure ulcer and decubitus ulcer all mean the same thing. These wounds nearly always sit over a bone that lies close to the skin, such as the tailbone, the hip, the heel, the ankle or the back of the head.

A pressure injury is not always an open sore. It can begin as a patch of unbroken skin that looks or feels different, and it can also be a deep crater. Clinicians describe that range with a staging system based on how many layers of tissue are involved. Staging gives everyone caring for the person a shared language for the wound.

What the treating clinician looks at

The first visit starts with a close look at the wound itself. The treating clinician notes exactly where it is, measures its length, width and depth, and checks whether it extends under the skin edges. The type of tissue in the wound bed matters, as does the amount and color of drainage and the condition of the skin around it.

From these findings the clinician assigns a stage, or records that the wound cannot be staged yet because its base is hidden. The same measurements are repeated at later visits. Comparing them over time is how the clinician judges whether the current orders are working or need to change.

Pressure injury and bed sore care in the Metro East

Some people in the Metro East have long crossed the river to St. Louis for specialty care. With a pressure injury, that trip means extended sitting in a car and then a clinic chair, which works against the wound. Gateway can check whether a partner clinician is available to visit the home or facility on the Illinois side instead. Coverage and the treating provider are confirmed before the visit, and records from hospitals in either state are gathered for the clinician.

The Metro East is the Illinois side of the St. Louis region: St. Clair, Madison and Monroe counties, running from Alton and Godfrey in the north to Columbia and Waterloo in the south. It takes in river towns on the floodplain, older cities such as Belleville and Granite City, growing suburbs like Edwardsville and O’Fallon, and farm communities to the east. A good deal of the region’s specialty care sits across the river in Missouri, and a bridge crossing is a real obstacle for someone who is frail or in pain. Care arranged close to home matters here.

Care at home

A home visit shows the treating clinician things an office visit cannot: the mattress the person actually sleeps on, the chair they sit in most of the day, and how transfers happen in that room. For a pressure injury, those details are often the cause of the wound.

Gateway schedules the visit with a partner clinician once availability is confirmed for your address. Leave the bed and chair set up as they normally are. If the person uses a cushion, pillows or a lift, keep them in place. The clinician decides how often to return based on how the wound is doing.

Care in skilled nursing and assisted living

In a skilled nursing facility, pressure injury care is a shared job. Facility nurses do the daily dressing changes and repositioning, the attending physician oversees the resident’s overall care, and a partner wound clinician can see the resident on site, often during scheduled wound rounds.

After each visit, measurements, staging and updated orders go to the nursing team so the chart and care plan match what the clinician found. Gateway coordinates the rounding schedule, the list of residents to be seen and the supply follow-up. Staff can also call Gateway between rounds when a resident’s wound changes.

Changes to report

An infected pressure injury can make the whole body sick, and in frail older adults the first sign is often a change in behavior, not a change in the wound. Contact the treating clinician promptly about:

  • Fever or shaking chills
  • Redness, warmth or swelling spreading out from the wound
  • Pus or cloudy drainage
  • Pain that is new or clearly worse
  • New confusion, unusual sleepiness or refusing food and drink

Call 911 if the person is very confused or unresponsive, is breathing fast or with difficulty, or looks suddenly and seriously ill.

Primary care and overall health

Several everyday medical issues affect how much pressure the skin takes. Medications that cause drowsiness can reduce the small movements a person makes while sitting or sleeping. Untreated pain makes people hold still and resist turning. Diarrhea, urinary infections and constipation with leakage keep skin wet. Stiff, contracted joints limit the positions a person can use.

A primary care clinician can review the medication list, pain control, bowel and bladder problems and whether therapy would help with mobility. Do not stop or change a medication on your own. Bring the concern to the clinician, and ask Gateway to share it with the wound care team as well.

Primary care at home in the Metro East →

Arranging pressure injury care in the Metro East

If you have been managing a wound mostly on your own and are looking for pressure injury care in the Metro East, you can call Gateway yourself at 314-325-0126. Tell us what the wound looks like now, what the last clinician said about it and what is getting harder to manage. It helps to know the patient’s insurance and the names of the doctors involved, but do not wait until you have everything. We check whether a partner clinician can see the patient at home or in their facility, and we tell you what we find. The treating clinician takes it from there, and you stay part of the conversation.

Because the Metro East covers three counties, the first thing we ask for is the town and ZIP code. After that, have a phone number, the type of residence, the patient’s doctors and the dates of any recent hospital stay ready. Gateway arranges care in Belleville, Edwardsville, O’Fallon, Collinsville, Alton and Granite City, among other communities. Distances are long from one end of the region to the other, so availability is confirmed by location and care setting for each request.

  • County: St. Clair, Madison and Monroe counties, Illinois
  • Nearby hospitals: Memorial Hospital Belleville; Memorial Hospital Shiloh; HSHS St. Elizabeth's Hospital in O'Fallon, Illinois; Anderson Hospital in Maryville; Alton Memorial Hospital; OSF Saint Anthony's Health Center in Alton; Gateway Regional Medical Center in Granite City; Touchette Regional Hospital in Cahokia Heights (not affiliated with Gateway)
  • Nearby communities: Belleville, Illinois, Edwardsville, O'Fallon, Illinois, Collinsville, Alton, Granite City
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in the Metro East

Read the full guide to pressure injuries, or see everything Gateway arranges on the mobile wound care in the Metro East page.

Common questions

Will insurance pay for pressure injury care or a special mattress in the Metro East?

It depends on the plan, the treating provider and the care that is needed. You can ask us about Medicare, Medicare Advantage, Medicaid and commercial plans, and we will help you find out what applies before a visit. Equipment such as a support surface usually requires a clinician’s order and supporting documentation, and each plan sets its own rules.

Can sitting in a wheelchair or recliner cause a pressure injury?

Yes. Sitting puts much of the body’s weight on a small area under the sitting bones and tailbone, so pressure injuries can form in a chair as readily as in a bed. People who sit most of the day need a suitable cushion and regular changes of position. The treating clinician can advise on the cushion and on how long the person should sit at a stretch.

What is debridement, and will my family member need it?

Debridement means removing dead tissue from a wound so healthy tissue can grow and infection is less likely. There are several methods, some using dressings or ointments and some done by a clinician with instruments. Not every pressure injury needs it, and in some situations it is avoided. The treating clinician decides whether, when and how, and will explain the reasons.

Can I ask about Illinois Medicaid or a Medicare Advantage plan for care in the Metro East?

You can ask about Medicare, Medicare Advantage, Medicaid and commercial plans. Participation and benefits depend on the treating provider, the plan and the care needed, so coverage cannot be discussed without the plan details. Have the insurance card in hand when you call. Illinois and Missouri run separate Medicaid programs, so mention that the patient lives in Illinois.

General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.